Unpublished

AN ESTIMATE OF SUBSTANCE USE IN FIRST EPISODE PSYCHOSIS

ABSTRACT

Background: Substance use is common in first episode psychosis patients and it has emerged as one of the greatest obstacles in treatment and good prognosis of the illness. The high prevalence of substance use in patients with first episode psychosis and its association with socio-demographic variants found in the study is a major trigger point for future need of studies on a larger scale. The deleterious impact of substance use in the prognosis of illness signifies the importance of identifying and addressing this issue.

Objectives: The aim of the study was to estimate prevalence of substance use in patient with first episode psychosis and to find out the association of sociodemographic variables in Nepal ese population. Method: All patients with first episode psychosis attending the Department of Psychiatry and Mental Health, TUTH were selected based on inclusion and exclusion criteria. A semi structured proforma was used to record the socio-demographic variables and psychiatric diagnosis was made according to ICD-10 DCR by a consultant psychiatrist. The clinical evaluation and severity of symptoms has been obtained using BPRS- E (Extended version).

Result: The result showed that 47.5% of first episode psychosis patient had a current or lifetime history of substance use. Alcohol was the most commonly used substance (52.6 %) followed by cannabinoids (26.3 %) and opioids (5.3 %),rests (15.8 %) were multiple substance users. There was significant association found in between demographic profiles and substance use. Substance use was more common among males, unemployed, people with education up to secondary level and in age group of 15-25 years. Cannabis use was associated with younger age and earlier onset of 2 psychotic illness compared to alcohol use. Substance users presenting with first episode psychosis have obtained a significantly higher score in hostility, elevated mood, grandiosity, suspiciousness, bi zarre behavior, uncooperati veness, self - neglect, disorientation, conceptual disorganization, blunted affect, excitement, distractibility, motor hyperactivity items of BPRS (p < 0.05) compared to those who did not use substance.

Conclusions: Substance use was found to be common among newly diagnosed first episode psychotic patients, alcohol being the most common used substance. There was a significant association with the socio- demographic variables for substance use. The study calls for the need to develop services that address substance use in first episode psychosis. Profiles of substance use in psychosis shows clinical and demographic gradients that can inform treatment and preventive research for better management and a help develop treatment protocol for these subgroup of patients.